Enteral Feedings Flashcards
What is enteral nutrition?
Provision of nourishment in liquid form directly into the stomach or upper intestine through a feeding tube
When is enteral nutrition indicated?
- To provide nutritional support
- To prevent/treat malnutrition
What are the advantages of enteral feeding compared to parenteral feeding?
- Easier, safer, less expensive, and more physiologic.
- Better utilized by the body.
- Maintains the structure and functional capacity of the GI tract
- Prevents cholestasis by stimulating bile flow.
- Improves systemic immunity and lowers risk for infection
What are the different routes for enteral feeding?
- Nasogastric,
- Nasointestinal/Nasoenteric (Nasoduodenal, Nasojejunal)
- Gastrostomy
- Jejunostomy
How long does an enteral feeding usually take?
4 hours
What needs to be done before every enteral feeding in an open system?
Wash the bag before adding formula
What is a Gastrostomy tube? What is it used for?
- Stoma created in abdominal wall
- Permits a short feeding tube to be inserted into the stomach
When can a patient with a newly inserted gastrostomy tube begin feeding?
- If the patient underwent general anesthesia for gastrostomy, he may have an ileus for the first 24 hrs.
- Gastric decompression is usually ordered until bowel motility returns to normal.
- Wait at least 24 hours after placement to begin feedings, as ordered.
What is a PEG tube (Percutaneous Endoscopic Gastrostomy) and what is it used for?
- Using an endoscope, tube placed into stomach
- Most popular approach for gastrostomy
- Held in place by internal/external retention device
- Holds on external piece allow air to reach skin and decrease risk of maceration
What is a PEG/J tube? (Percutaneous Endoscopic Gastrostomy-jejunostomy tube) What is it used for?
- Tube placed into stomach AND jejunum
- Used for gastric decompression and simultaneously deliver enteral feedings into jejunum
- Held in place by internal/external retention devices
How do we confirm the placement of an enteral feeding tube? How often do we check?
- Radiography to confirm location at first
- Check pH q4h afterwards
- Check placement before every intermittent feeding, and every shift for continous feeding
What is a Low-Profile Gastrostomy device? (LPGD). What is it for?
- Anchored in stomach (usually into mature gastrostomy tract) and protrudes above skin
- Permits greater independence and more acceptably cosmetic
What device is found on an LPGD tube?
- An antireflux valve to keep contents from leaking onto skin
- Difficult to accidentally dislodge, so ideal for children and confused patients
What medications can you not crush and send down a feeding tube?
Anything long-acting or has enteric coating
What is a Jejunostomy tube? What is it used for?
- Placed in jejunum
- Used for long-term post-plyroric enteral feedings when bypassing the stomach is desirble (gastric disease, abnormal emptying, upper GI obstruction, etc.)
When are jejunostomy’s contraindicated?
Small bowel disease (radiation enteritis, Crohn’s disease) due to high risk of enterocutaneous fistual formations
What are the skin care considerations related to enteral feedings?
- Inspect skin around site daily
- Cleanse site daily using sterile cotton-tipped applicators
- Rotate gastrostomy tube 360 degrees daily
- Check for in-and-out play of 0.5 cm
- Leave stoma site open to air
- Teach the patient to avoid tugging on the tube or lying on Left side after feedings.
How do we do ongoing placement verification after radiograph has confirmed its position?
- Measure external length of tube
- Aspirate gastric or intestinal contents
- Observe color
- Measure pH of aspirated contents
- Consider results from pH testing & the aspirate’s appearance
- Insufflate air into tube and auscultate
- When in doubt, hold feeding and xray
What are some ongoing problems associated with enteral feedings?
- Aspiration
- Diarrhea
- Clogged feeding tube
- N/V, abdominal distention, cramping
- Dehydration
- Hyperglycemia
- Electrolyte imbalance
What are the classifications of enteral formulas?
- Polymeric
- Modular
- Elemental
- Specialty
How do we prepare formula in an open system?
- Reconstitute formula from powder with milk or water
- Once mixed, refrigerate
- Allow to stand at room temperature for at lest 20 mins. to warm
- Unused quantities discarded after 24 hrs.
- Hang only 4 hours worth of formula
How do we prepare formula in a closed system?
- Ready for immediate use
- Unopened, stable at room temperature
- Stable for 48 hours once hung
What is involved in patient preparation and follow-up?
1) Assist to semi- or high Fowler’s position
2) Check placement of feeding tube
3) Administer feeding
4) Administer supplemental water if ordered
5) Leave patient comfortable, maintaining position for minimum 30 mins.
How do do intermittent feeding?
- Pinch proximal end of feeding tube
- (OPTION A): remove plunger from syringe and attach barrel to end of tube. Fill syringe with measured amount of formula. Release tube and hold syringe high enough to allow it to empty gradually by gravity.
- (OPTION B): hang feeding bag of prescribed amoung on IV pole. Purge tubing, connect distal end of tubing to proximal end. Connect tube through infusion pump and set rate.
